Don’t wait until you get sick: What you can do to prevent heart disease.

I have been writing recently about heart disease, how it is diagnosed, and what you and your doctor can do to treat it. In order for your doctor to start treating you for heart disease risk factors such as high blood pressure, high cholesterol, or diabetes you need to be diagnosed with one of these conditions. This requires proactively seeing your physician for screening before you start experiencing the consequences of these conditions.

But most people don’t visit their doctor until they have symptoms, and many wait until a more serious event (a heart attack, for example) occurs to seek medical attention. By this time, the disease process has progressed and managing it becomes the goal. It is possible to prevent both the conditions that lead to heart disease as well as reduce the risk that you may have a heart attack or stroke.

Your risk of heart disease is largely determined by health-related attributes and behaviors called risk factors. Some of these risk factors cannot be changed, including age, sex, and family history. Other risk factors are modifiable, meaning you can change them to reduce your risk. These modifiable risk factors include smoking, high blood pressure, high cholesterol, diabetes, obesity, and physical inactivity.

While there are medications that can lower blood pressure and cholesterol and treat diabetes, these modifiable risk factors are best addressed by lifestyle changes. Adopting healthy habits has the potential to have a bigger effect on heart attack risk than medical management. There are three important health behaviors that, together and separately, have a powerful effect on reducing heart attack risk:

Stop smoking. There is no way around this one. Quit! Ask your doctor about prescription medications that can make quitting easier. Nicotine replacement therapy in the form of patches, gum, and lozenges can help manage cravings and are available over the counter. Ultimately, though, quitting smoking is a behavior change that takes motivation, willpower, and time. But it is worth it—your risk of heart attack can drop 50–70% within five years of quitting.

Be active everyday. The importance of physical inactivity as a risk factor for heart disease is often overlooked. But make no mistake, being active on a regular basis is one of the most important things you can do to improve your heart health. Whether you have other risk factors or not, physical activity can reduce your chance of having a heart attack. And if you do have a heart attack, your active lifestyle improves your chances of survival and returning to a normal lifestyle.

The benefits of exercise are well-established and impact heart disease risk in a multitude of ways. Physical activity helps with weight control, lowers blood pressure, improves blood lipids, and prevents and treats diabetes. Think of this as a great health “deal.” By modifying one risk factor—inactivity—you can also promote beneficial changes in four others—obesity, hypertension, high cholesterol, and diabetes. There is no other treatment, drugs included, that can have such a broad impact on heart disease risk!

Improve your diet. If you are like most Americans, your diet is too high in saturated fat, salt, and added sugar and lacking adequate whole grains, fruits and vegetables, and fiber. This type of diet is associated with obesity, high blood pressure, high cholesterol, and diabetes. All of these conditions are risk factors for heart disease, so you may literally be eating your way to a heart attack.

It turns out that adopting a healthier eating pattern is important in reducing your risk of heart disease. Saturated fat intake can lead to abnormal blood lipids and high salt intake is linked to high blood pressure. While eating sugar doesn’t cause diabetes, the type of diet described above is associated with weight gain and diabetes. Just like with physical activity, a healthy diet can lead to improvements in several other risk factors.

The potential impact of these three health behaviors is great. Even modest changes in diet and activity can lead to improvements in risk factors and reduced heart attack risk. More intensive lifestyle modification can produce even greater benefits. In one famous study, daily exercise, a low-fat vegetarian diet, and stress management actually caused regression of heart disease, meaning that the blockages in the coronary arteries were smaller following treatment. While you may not follow such a strict program, becoming more active, eating a healthier diet, and quitting smoking can go a long way to improving your heart health.

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